For the fourth year in a row, health insurance costs are rising at double-digit rates. The California Public Employees' Retirement System, which buys health insurance for almost 2 million people, estimates that costs may be up as much as 25 percent in 2003.

Across the nation, health insurance increases are expected to average about 14 percent -- seven times the rate of inflation. Employers now pay about $3, 000 annually for single coverage and about $8,000 for family coverage. These increases are showing up on the bottom lines of health insurance companies. One of the country's largest, WellPoint (Blue Cross), reported profits for 2002 of more than $700 million, up 70 percent from a year earlier, and more than double its 2000 profits.

Drug costs account for about one-fifth of the growth of overall health care spending. In 2001, prescription drug spending nationally increased about 15 percent -- after a 16 percent increase in 2000. With more and increasingly effective drugs coming, their share of overall costs is likely to increase.

Hospital costs are not far behind. In 2001, hospital spending increased about 8 percent nationally, the highest rate of growth since 1991. Americans spent about $451 billion on hospital care in 2001, only slightly less than the $462 billion spent on physicians and other professional medical services. The main drivers of hospital cost increases are a big jump in demand for services and higher wages closely tied to a shortage of licensed health professionals.

One of the greatest, and least recognized, causes of increased costs is federal and state laws. There are over 136,000 pages of Medicare regulations. More than 20 separate agencies oversee health care in California without coordination. Laws to strengthen hospital buildings to withstand earthquakes may add $10 billion in new capital expenses between now and 2013, and new minimum staffing ratios for nurses may add another $500 million per year in salary expenses. These new requirements will show up on everyone's medical bills.

In all, health care spending in America tops $1.4 trillion. It is the nation's single largest source of spending -- more than 14 percent of the Gross Domestic Product. That is up from $245 billion in 1980 and $696 billion in 1990. National health spending could rise to $3 trillion by 2012.

The sad truth is, the current crisis of cost in health care is nothing new.

Since 1970, every time there has been a surge in health costs (about every decade), there has been a cry for a strong public policy response. In the 1970s, the Nixon administration instituted cost controls. In the '80s, Medicare moved to prospective payments. And in the '90s, businesses and government promoted HMOs as the answer to cheaper, more efficient care. Yet in the end, costs always continued to rise.

Initially, HMOs did help control costs, but they did so mostly through reducing access to care. The public rebelled against not being able to see a doctor when they needed to, and the insurance companies took a major step back from earlier restrictions.

Today's grand strategy for controlling costs appears to be to force individual consumers to lessen their demands for care.

Employers are shifting health insurance increases to employees through bigger co-payments and higher deductibles. About 78 percent of all large companies say they will continue to shift costs. Employers are growing interested in "defined contribution" plans, in which employees are given a set amount of money to buy health benefits, instead of traditional "defined benefit" plans, in which employees choose from a number of employer-paid health plans.

Whether we can bring health costs under control by shifting the burden to individuals is debatable. What is clearer is that the current system cannot be sustained. While costs are increasing, access to care is not. Financing is becoming unstable. Quality remains elusive. And governmental control is growing.

Any lasting solution must pass four crucial tests: It must increase access, stabilize finances, improve quality and improve governmental oversight.

With reform, will people receive the care they need soon enough to make a difference, and will it be provided with dignity? Will reform ensure that everyone shares equitably in contributing to the cost of care and makes prudent decisions about the use of care? Will reform increase the effectiveness of diagnostic and treatment technologies? And, under reform, will government take responsibility for the effects of its regulations?

Good health care is a fundamental human right. Society should make it available, just as we provide clean water, adequate roads and a national defense.